Observed survival benefit of mild therapeutic hypothermia reanalysing the Circulation Improving Resuscitation Care trial.

Background: Mild therapeutic hypothermia is argued being beneficial for outcome after cardiac arrest.

Materials And Methods: Retrospective analysis of Circulation Improving Resuscitation Care (CIRC) trial data to assess if therapeutic cooling to 33 ± 1 °C core temperature had an association with survival. Of 4231 adult, out-of-hospital cardiac arrests of presumed cardiac origin initially enrolled, eligibility criteria for therapeutic hypothermia were met by 1812.

Safety and feasibility of the RhinoChill immediate transnasal evaporative cooling device during out-of-hospital cardiopulmonary resuscitation: A single-center, observational study.

We investigated feasibility and safety of the RhinoChill (RC) transnasal cooling system initiated before achieving a protected airway during cardiopulmonary resuscitation (CPR) in a prehospital setting.In out-of-hospital cardiac arrest (OHCA), transnasal evaporative cooling was initiated during CPR, before a protected airway was established and continued until either the patient was declared dead, standard institutional systemic cooling methods were implemented or cooling supply was empty. Patients were monitored throughout the hypothermia period until either death or hospital discharge.

Manual vs. integrated automatic load-distributing band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial.

Objective: To compare integrated automated load distributing band CPR (iA-CPR) with high-quality manual CPR (M-CPR) to determine equivalence, superiority, or inferiority in survival to hospital discharge.

Methods: Between March 5, 2009 and January 11, 2011 a randomized, unblinded, controlled group sequential trial of adult out-of-hospital cardiac arrests of presumed cardiac origin was conducted at three US and two European sites. After EMS providers initiated manual compressions patients were randomized to receive either iA-CPR or M-CPR.

Strategic target temperature management in myocardial infarction--a feasibility trial.

Objective: The purpose of this study was to demonstrate the feasibility of a combined cooling strategy started out of hospital as an adjunctive to percutaneous coronary intervention (PCI) in the treatment of ST-elevation acute coronary syndrome (STE-ACS).

Design: Non-randomised, single-centre feasibility trial.

Setting: Department of emergency medicine of a tertiary-care facility, Medical University of Vienna, Vienna, Austria.

Exposure to carbon monoxide for patients and providers in an urban emergency medical service.

Background: Carbon monoxide (CO) poisoning poses danger to both patients and emergency medical services (EMS) personnel, as its symptoms are nonspecific and EMS is currently not equipped to detect CO in ambient air.

Objective: We aimed to assess the degree of non-fire-related CO exposure at the high-volume EMS system of a city with 2 million inhabitants.

Methods: The EMS system was equipped with handheld CO detectors (Dräger Pac 3500), which were added to EMS standard backpacks and had to be carried to the patient at all times.

Out of hospital cardiac arrest in Vienna: incidence and outcome.

Aim Of The Study: To determine the incidence of out-of-hospital cardiac arrest and the survival rate of those patients who received CPR in the city of Vienna.

Methods: A cohort of patients with out-of-hospital cardiac arrests and who were treated by the Vienna Ambulance Service between January 1, 2009, and December 31, 2010, were followed up until either death or hospital discharge. The associations of survival and neurological outcome with their potential predictors were analysed using simple logistic regression models.

Randomized crossover trial comparing physical strain on advanced life support providers during transportation using real-time automated feedback.

Background: Feedback devices provide verbal and visual real-time information on cardiopulmonary resuscitation (CPR) quality. Feedback devices can improve the quality of CPR during transportation. It remains unclear if feedback has an effect on the physical strain felt by providers during ongoing CPR.

Randomized placebo controlled trial of furosemide on subjective perception of dyspnoea in patients with pulmonary oedema because of hypertensive crisis.

Background: To compare the administration of furosemide with placebo on the subjective perception of dyspnoea in patients with acute pulmonary oedema because of hypertensive crisis. Design  Randomized, controlled and double-blinded clinical trial.

Setting: Municipal emergency medical service system and university-based emergency department.

Design of the Circulation Improving Resuscitation Care (CIRC) Trial: a new state of the art design for out-of-hospital cardiac arrest research.

Purpose: Mechanical chest compression devices, such as the AutoPulse(®), have been developed to overcome problems associated with manual CPR (M-CPR). Animal and human studies have shown that AutoPulse CPR improves hemodynamic parameters over M-CPR. However, human studies conducted in the prehospital setting have conflicting results as to the AutoPulse's efficacy in improving survival.

Comparison of two new generation pulse oximeters during emergency ambulance transportation.

Objectives: We wanted to test whether there is a difference between the total number and duration of malfunctions and a correlation between the oxygen saturation and pulse rate values of two new generation pulse oximeters (Masimo 'Radical 7' and Nellcor 'N 600') during emergency ambulance transportation.

Methods: Patients were monitored with two pulse oximeters ('Radical 7' and 'N 600') on different randomly selected fingers of the same hand during transportation. Data of both devices were recorded continuously by a laptop computer.

Quality of closed chest compression on a manikin in ambulance vehicles and flying helicopters with a real time automated feedback.

Context: Automated verbal and visual feedback improves quality of resuscitation in out-of-hospital cardiac arrest and was proven to increase short-term survival. Quality of resuscitation may be hampered in more difficult situations like emergency transportation. Currently there is no evidence if feedback devices can improve resuscitation quality during different modes of transportation.

Out-of-hospital surface cooling to induce mild hypothermia in human cardiac arrest: a feasibility trial.

Aim: The earliest initiation of mild hypothermia after resuscitation from cardiac arrest is crucial. This study aimed to evaluate the feasibility and safety of out-of-hospital surface cooling in such cases.

Methods: Cooling pads stored below 0 degrees C in the ambulance were applied as soon as possible after restoration of spontaneous circulation in the out-of-hospital setting.

Results from Austria's nationwide public access defibrillation (ANPAD) programme collected over 2 years.

Aim Of The Study: To analyse 2 years of experience after introducing automated external defibrillators (AED) all over Austria.

Materials And Methods: This observational study evaluated the number of privately purchased devices and the rate of local bystander-triggered AED deployments from November 2002 to December 2004. As outcome measurements, the hospital discharge rate and neurological condition were recorded.

Physical strain on advanced life support providers in different out of hospital environments.

Objectives: To examine to what extent the type of emergency medical transportation influences the physical response of advanced life support providers.

Background: Providing external chest compression during resuscitation is physically exhausting. If the decision is made to bring the patient to a hospital undergoing resuscitation procedures, there are usually two options for transportation: ambulance vehicles or helicopters.

Quality of closed chest compression in ambulance vehicles, flying helicopters and at the scene.

Context: Transport of patients during resuscitation is a critical procedure. In both, ambulances and helicopters the quality of resuscitation is potentially hampered due to the movement of the vehicle and confined space. To date, however, no direct comparison of the quality of resuscitation at the scene, during a helicopter flight and in a moving ambulance has been made.

Implementation of guidelines improves the standard of care: the Viennese registry on reperfusion strategies in ST-elevation myocardial infarction (Vienna STEMI registry).

Background: The purpose of this study was to determine whether implementation of recent guidelines improves in-hospital mortality from acute ST-elevation myocardial infarction (STEMI) in a metropolitan area.

Methods And Results: We organized a network that consisted of the Viennese Ambulance Systems, which is responsible for diagnosis and triage of patients with acute STEMI, and 5 high-volume interventional cardiology departments to expand the performance of primary percutaneous catheter intervention (PPCI) and to use the fastest available reperfusion strategy in STEMI of short duration (2 to 3 hours from onset of symptoms), either PPCI or thrombolytic therapy (TT; prehospital or in-hospital), respectively. Implementation of guidelines resulted in increased numbers of patients receiving 1 of the 2 reperfusion strategies (from 66% to 86.